What do you do when a patient threatens harm?

[OrganizedChaos]

So far in my short few months on the floor I've already had a bunch of patients threaten to hit me. Every time I get threatened or yelled at by the public all I can think of is that I'm not getting paid enough to put up with this ****.

What do you do when someone just threatens violence? If I just called security on my ascom who knows when they would show up. But I don't feel the need to call a code since nothing is actually happening & I don't want to make the patient more irate.

Yesterday I was trying to remove a patient's IV (she was being D/C'd). She had paper thin skin & lots of tape. I was trying to go as slow as possible & use ETOH pads & then hand sanitizer. She wasn't good with pain & at one point she said she was going to punch me in the face. What do you do in a situation like that? I just quickly changed the conversation & de-escalated her, then she was fine.

[OrganizedChaos, LVN]

This is great- in theory.

In my experience, courses offered by the hospital seem more geared to reducing liability for the hospital by establishing a standard of care, and training for it.

While some of the principles taught for de-escalation are reasonable, most of the physical techniques taught to protect oneself are useless and potentially dangerous.

The techniques I have been taught could be used to get a 90 y/o LOL to let go of you, and do so without hurting her. Which is nice.

Actually physically defending yourself from a real assault takes hundreds or thousands of hours of practice- not a 2 hour session once a year.

True. It would probably be best to take some kind of martial arts.

[Beldar_the_Cenobite, CNA]

... If anyone ever hit me I would press charges in a min with exception of Alzheimer's, dementia very young children..

Children can get dementia?

[Ruby Vee, BSN]

We really do. I had a conversation with a coworker about it yesterday. I can't tell you how many times a code is called for security. We should be able to carry mace.

There was a patient on the floor who got irate & had a pocket knife. You're telling me I have a whip out my ascom, call a code & wait for security to get there?

It's one thing if a patient is verbally abusive when if someone ever starts to become physically abusive with me, I will do whatever it takes to protect myself. I have 2 little ones at home & I want to go home at the end of the day.

We all want to go home at the end of the day. Little ones or no.

[Ruby Vee, BSN]

What kind of "code" would you be calling? Does your facility have a "code green" or some such that reflects a threat made against your person?

Ours would be a "Code Gray".

[Ruby Vee, BSN]

Legal trouble? People are allowed to protect ourselves -- if the assailant is killed the victim isn't charged with murder, right? Besides, Maslow's Heirarchy people. My need for survival is more than my need to avoid a courtroom.

It's amazing who is allowed to protect themselves and who isn't. Stranger accosting you on the street -- you're allowed to protect yourself. Husband threatening you with a knife -- you're as likely to go to prison for shooting him as you are to go to heaven for not shooting him. Patient threatening you in a hospital? No one goes to jail, but often someone loses their job.

[pixierose, BSN, RN]

This is great- in theory.

In my experience, courses offered by the hospital seem more geared to reducing liability for the hospital by establishing a standard of care, and training for it.

While some of the principles taught for de-escalation are reasonable, most of the physical techniques taught to protect oneself are useless and potentially dangerous.

The techniques I have been taught could be used to get a 90 y/o LOL to let go of you, and do so without hurting her. Which is nice.

Actually physically defending yourself from a real assault takes hundreds or thousands of hours of practice- not a 2 hour session once a year.

But it's better than nothing.

I received a 16 hour training in CPI, to be completed yearly.

Unfortunately, I had to use a few of the moves taught while working on a psych floor. Several potential hair pulls, one almost choke and multiple moves from patients coming at me ... The moves prevented injury on my part ... and on theirs.

[hppygr8ful, ASN, RN, EMT-I]

The last 2 hospitals I've worked at "Code Grey" is the code for violent patient/family. In psych we all wear panic alarms and a hit to the button calls the code. Alarms go off all over the unit, security comes running, as well as staff from other psych floors.

We don't have this panic button you speak of but we have a pretty good system for calling codes and help come quickly.

Hppy

[hppygr8ful, ASN, RN, EMT-I]

With how you describe what you're doing, if I were in that position, I would probably look at her while doing what you're doing and tell her, "Don't, I'm trying to do my job for you, so you can get out of here and go back to your normal life."

This might further antagonize an already angry patient and would most likely get you socked.

Hppy

[hppygr8ful, ASN, RN, EMT-I]

This is great- in theory.

In my experience, courses offered by the hospital seem more geared to reducing liability for the hospital by establishing a standard of care, and training for it.

While some of the principles taught for de-escalation are reasonable, most of the physical techniques taught to protect oneself are useless and potentially dangerous.

The techniques I have been taught could be used to get a 90 y/o LOL to let go of you, and do so without hurting her. Which is nice.

Actually physically defending yourself from a real assault takes hundreds or thousands of hours of practice- not a 2 hour session once a year.

I have not had hundreds or even thousands of hours of practice and have successfully defended myself multiple times, including a mugging that occurred in a parking lot. Left that guy with a good set of bite marks. Yes you do need to practice these techniques and it's good to role play with co-workers. But the essence of these training programs is to teach you 1. How to avoid these situations in the 1st place 2. How to deflect an attack and 3. what to do if somebody gets their hands on you. I had not used these techniques in years and was at a snf starting IV.'s when a large combative man with a TBI came at me with a dinner fork - I took his arm spun him around and sat him on the floor. A supervisor came around the corner and said "What happened? Did he fall?" I said "No he was walking and lost his balance and I gently assisted him to the floor."

You will never learn to be a martial arts master in these classes but knowing what to do in a situation when a patient becomes aggressive goes a long way towards protecting yourself and your patient.

Hppy

[hppygr8ful, ASN, RN, EMT-I]

I did an 8 hour CPI course on Wednesday, this training counts toward our nursing CEUs??

There should be information on your certificate re: if it can be used for CEU's. I have always submitted mine with no problem. Now that I am again in Psych full time we do MAB stand for management of assaultive individuals. This one I also submitted with no issues.

Hppy

[Kooky Korky, BSN, RN]

We have codes for everything: patient fall, security, etc.

Most of the people who have threatened me were A&Ox3-4. Never the LoL who wasn't aware.

In many years working in nursing homes with dementia patients, and in jails and psych wards, adult and juvenile, acute and chronic, no one has ever threatened me. Honestly, I am wondering about your approach to patients if you are getting what sounds like many threats.

[OrganizedChaos, LVN]

We all want to go home at the end of the day. Little ones or no.

Of course, I was just speaking about myself.